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Medical Forum / Diseases and Disorders / Asthma / June 2006Advair side effects
Hi all, This is my first post as I just found this site. I am asthmatic and have been for most of my life. I have been on Advair 550/50 for awhile now, along with Theophyllin. I recently went off Singulair. I am weaning myself off tha Advair and have noticed that I am soooo tired. Has anyone that has weaned themselves off this noticed this? I also started having joint pain in my hands and arms a couple of years ago. No doctor, not even a naturopath, could tell me why. After reading some of the posts here, I'm wondering if it is the Advair. The pain comes and goes, but seems to be more prevelant since starting the weaning process. Thanks in advance for any help!! > Hi all, > This is my first post as I just found this site. I am [quoted text clipped - 16 lines] > weaning process. > Thanks in advance for any help!! You're probably not getting enough oxygen, which can cause fatigue. Why are you weaning yourself off Advair, and are you doing this under the supervision of someone with a medical degree? Hi all, This is my first post as I just found this site. I am asthmatic and have been for most of my life. I have been on Advair 550/50 for awhile now, along with Theophyllin. I recently went off Singulair. I am weaning myself off tha Advair and have noticed that I am soooo tired. Has anyone that has weaned themselves off this noticed this? I also started having joint pain in my hands and arms a couple of years ago. No doctor, not even a naturopath, could tell me why. After reading some of the posts here, I'm wondering if it is the Advair. The pain comes and goes, but seems to be more prevelant since starting the weaning process. Thanks in advance for any help!! Hello, You should not stop taking Advair until you discuss this situation with your doctor. Please request a blood and urine test and post any results that are outside the nornal limits. Also, post the urine pH level. it's difficult to help you unless we know more details. I am not a doctor but did spend time working in a hospital. Do you have any other health problems that you did not mention in your post? Jason > In article > <1148385886.163232.271590@g10g2000cwb.googlegroups.com>, [quoted text clipped - 33 lines] > problems that you did not mention in your post? > Jason I would think the original poster's doctor would be capable of ordering appropriate tests, and then interpretting the results. "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2305061247050001@66-52-22-49.lsan.pw-dia.impulse.net... > In article > <1148385886.163232.271590@g10g2000cwb.googlegroups.com>, [quoted text clipped - 34 lines] > problems that you did not mention in your post? > Jason I would think the original poster's doctor would be capable of ordering appropriate tests, and then interpretting the results. It's possible for patients to request blood tests. Of course, the original poster should listen to the doctor as the doctor intreprets the results. The original poster can also ask other people to give their opinions related to the results. In medical newsgroups, people post the results of their blood tests on a regular basis and ask for advice related to results that are outside of normal. I am sure you have seen such posts. Jason > In article <8a6dnRpHwo5q6-7ZRVn-sQ@comcast.com>, > "NorthShoreCEO" [quoted text clipped - 56 lines] > outside of normal. I am sure you have seen such posts. > Jason I don't think it's wise for a patient, who doesn't appear to be working with their doctor, to suddenly go in and request blood tests. The poster should be working with their doctor and the doctor will recommend what tests are needed. Yes, I've seen such posts, but the problem with posting results is then you have every idiot on the internet interpretting those results and making recommendations, when none of them are fit to. The best advice to give the poster is to work with their doctor, who will recommend appropriate tests and go over the results and what they mean. > The poster should be working with their doctor and the > doctor will recommend what tests are needed. I firmly believe the best way to improve ones health is to realize you are the only one responsible for your own health, not anyone else including your Dr. To me my Dr's are one of many resources I use in solving health issues. Far too many people simply do whatever the Dr. says without question. I do ask my Dr. a ton of questions and based on what I find with him as well as other sources I often do request various tests. I treat myself. My Dr. is only a resource to help me to do that. >> The poster should be working with their doctor and the doctor >> will recommend what tests are needed. [quoted text clipped - 7 lines] > as well as other sources I often do request various tests. I > treat myself. My Dr. is only a resource to help me to do that. I'm a firm believer that everyone should read as much as they can about their health and be their own advocate while working with their doctor. If I didn't believe this, I wouldn't have been asthma and asthma med free for three years. However, the original poster is doing something that isn't safe, apparently. You don't just cut your asthma meds on your own and then wonder why you're fatigued. This is not the time to tell a person, "You're responsible for your own health." >> The poster should be working with their doctor and the >> doctor will recommend what tests are needed. > >I firmly believe the best way to improve ones health is to realize you >are the only one responsible for your own health, not anyone else >including your Dr. He said to work *with* their doctor. > To me my Dr's are one of many resources I use in >solving health issues. Far too many people simply do whatever the Dr. >says without question. And other people think that they know better than the doctor and fail to comply with a doctor's recommendation even though it is best for them. > I do ask my Dr. a ton of questions and based on >what I find with him as well as other sources I often do request various >tests. I treat myself. My Dr. is only a resource to help me to do that. So how do you prescribe medications or order lab tests for yourself? You cannot treat yourself unless you have an MD degree or you choose to not take medication or get blood tests. A person who acts as his own doctor has a fool for a patient. Just because you ask for a medication or blood test does not mean that the doctor will agree. You may not like it but you are dependent on the doctor for a number of things. RC > He said to work *with* their doctor. He also said let the Dr. decide which tests are needed. I believe I am the final say on my treatment. Not my Dr. Define *work* with? I listen to my Dr.'s advice and expertise and then I decide the course of action to take. > And other people think that they know better than the doctor and fail > to comply with a doctor's recommendation even though it is best for > them. How does one know what ever the Dr. says is whats best for them? > You cannot treat yourself unless you have an MD degree or you choose > to not take medication or get blood tests. A person who acts as his > own doctor has a fool for a patient. Bull. A person who simply goes to a Dr. and blindly does whatever the Dr. says is a fool. People MUST take responsibility for themselves. Take the time to understand their ailment and treatment. The Dr. is one resource to do that. Different Dr.s will have different solutions to a particular issue. Some solutions are wrong, some are right. It's the patient who must find out what will work for them. The only area where you and I agree is that a person should not make blind decisions. > You may not like it but you are dependent on the doctor for a number > of things. True to an extent. But the Dr. is not and should not be the end voice in my healthcare. I am. >> He said to work *with* their doctor. > > He also said let the Dr. decide which tests are needed. I believe I am > the final say on my treatment. Not my Dr. That is only partially true. Basically you each have the power of veto over each other. He can't make you take a test or med you don't want to take but you can't get a med or test without his consent. Seems to me that to make any progress you need to work together. > Define *work* with? I listen to my Dr.'s advice and expertise and then I > decide the course of action to take. Only to a point. It is more accurate to say that you decide what action not to take. >> And other people think that they know better than the doctor and fail >> to comply with a doctor's recommendation even though it is best for >> them. > > How does one know what ever the Dr. says is whats best for them? How does one know it is not? >> You cannot treat yourself unless you have an MD degree or you choose >> to not take medication or get blood tests. A person who acts as his [quoted text clipped - 5 lines] > to do that. Different Dr.s will have different solutions to a particular > issue. All of that is true. > Some solutions are wrong, some are right. Sure, sometimes people get prescribed something that is just not right but most often the options are different degrees of right. > It's the patient who must find out what will work for them. The only area > where you and I agree is that a person should not make blind decisions. [quoted text clipped - 4 lines] > True to an extent. But the Dr. is not and should not be the end voice in > my healthcare. I am. That attitude will get you nowhere fast. Sometimes there are several reasonable options for treatment and in those cases the patient should have a large say in the matter. Often there are not all that many reasonable options and the correct course is fairly clear. In those situations people taking the attitude you espouse end up hurting themselves.  Signature00doc > Only to a point. It is more accurate to say that you decide what action not > to take. True to a point. If I decide the best course of action for me to take is different than that of my Dr.'s I have the choice to go find another Dr. >> How does one know what ever the Dr. says is whats best for them? > > How does one know it is not? My point exactly. It is the patient who must decide. They are the only ones to benefit or suffer as a result of a course of action. The Dr. won't. A persons health is their own responsibility, not the Dr.'s. >> True to an extent. But the Dr. is not and should not be the end voice in >> my healthcare. I am. [quoted text clipped - 4 lines] > options and the correct course is fairly clear. In those situations people > taking the attitude you espouse end up hurting themselves. What attitude is that? I never said to simply disagree with a Dr. without reason. What I am saying is that the Dr. is a resource to use to help treat yourself. The responsibility lies with yourself in your treatment and not the Dr. I use my Dr.s knowledge so that I can better understand how to control my health issues. Case in point. I came down with some sorta nasty bug thats going around. After several weeks I finally went to the Dr. He told me I just have to let it run its course. After 2 months of coughing I went back. He gave me some cough syrup and was disinterested in why I had been coughing for so long. Now if I did what some here say I would be taking cough syrup and still coughing badly. Instead I went to another Dr. who at first prescribed an antibiotic. When I told him that particular antibiotic had never proved effective with me he changed it to what I said has worked before. A few days later I'm done coughing. Again, it is me that is responsible for my own health. Not my Dr. Otherwise I would still be coughing or worse. My Dr. is a resource and yes, one that can write prescriptions. >> Only to a point. It is more accurate to say that you decide what action not >> to take. > >True to a point. If I decide the best course of action for me to take >is different than that of my Dr.'s I have the choice to go find another >Dr. Why is it that I think that you have gone to more than your fair share of doctors as a result on not agreeing with their treatment plan? I don't know if this is true but you are coming across as someone who thinks he knows more than doctors about health care decisions and gets into confrontations with doctors. Sounds like you have a control problem. RC > Why is it that I think that you have gone to more than your fair share > of doctors as a result on not agreeing with their treatment plan? Fair share? What the heck is that? Is there a limit and then its game over? > I don't know if this is true but you are coming across as someone who > thinks he knows more than doctors about health care decisions and gets > into confrontations with doctors. Sounds like you have a control > problem. ROFL, seems to me that its you who doesn't like taking responsibility for your own issues. If I go to Dr.#1 for 4 years and follow his treatment and advice with no results I then go looking elsewhere. When Dr. #2 wants me to follow the exact same failed course of action then yes, I go on to Dr. #3 who may have some other course to try and takes the time to listen to me and find out what may work rather than go down the same failed path. Ya, when it comes to my health I do take control over it. It's my health after all. If I listened to you I would still be on Dr. #1's failed plan indefinably or more likely its all just psychological anyways. > ROFL, seems to me that its you who doesn't like taking > responsibility for your own issues. If I go to Dr.#1 for 4 > years and follow his treatment and advice with no results I > then go looking elsewhere. Again, you are being your own advocate. When > Dr. #2 wants me to follow the exact same failed course of > action then yes, I go on to Dr. #3 who may have some other > course to try and takes the time to listen to me and find out > what may work rather than go down the same failed path. Being your own advocate and working with your doctor. This is NOT the same as going into a doctor, TELLING him what tests you want, and posting the results on the internet for every weirdo to dissect and pontificate about. Ya, when it comes to my health I do take control > over it. It's my health after all. If I listened to you I > would still be on Dr. #1's failed plan indefinably or more > likely its all just psychological anyways. > Case in point. I came down with some sorta nasty bug thats > going around. After several weeks I finally went to the Dr. [quoted text clipped - 4 lines] > and still coughing badly. Instead I went to another Dr. who at > first prescribed an antibiotic. When you went to another doctor, you were being your own advocate. When I told him that > particular antibiotic had never proved effective with me he > changed it to what I said has worked before. A few days later > I'm done coughing. Again, it is me that is responsible for my > own health. Not my Dr. Otherwise I would still be coughing or > worse. My Dr. is a resource and yes, one that can write > prescriptions. This is "working with" your doctor. >> You may not like it but you are dependent on the doctor for a number >> of things. > >True to an extent. But the Dr. is not and should not be the end voice >in my healthcare. I am. This is true. You can keep going to different doctors before you finally find one who does what you want him/her to do even though it may not be the best course of action. Since an MD has had four years of medical school plus three or more years residency it is likely that the doctor would be best to determine what tests and what treatment should be implemented and not you. Can doctors make mistakes? Of course. That is why you get a second opinion if you question the judgement of the first doctor. RC > This is true. You can keep going to different doctors before you > finally find one who does what you want him/her to do even though it > may not be the best course of action. So just what is the best course of action? Whatever Dr. #1 says taken at face value? > Since an MD has had four years of medical school plus three or more > years residency it is likely that the doctor would be best to > determine what tests and what treatment should be implemented and not > you. Would that be Dr. #1's treatment recommendations or Dr. #2's who is completely different? Both have the same education. It is me that must decide. > Can doctors make mistakes? Of course. That is why you get a second > opinion if you question the judgement of the first doctor. Uhoh...2nd opinion? You just said the Dr. knows more than me so who am I to question Dr. #1??? BINGO!! We have a winner. I question everything when it comes to my health. I get 2nd and 3rd opinions if I have to. It is me that takes it all in and decides the best course of action for me. The Dr's are a valuable tool and resource for knowledge and advice. But it is my health at stake, not theirs. I have to decide whats best for me. The Dr.s help me to do that. NorthShoreCEO wrote: > The poster should be working with their doctor and the > doctor will recommend what tests are needed. I firmly believe the best way to improve ones health is to realize you are the only one responsible for your own health, not anyone else including your Dr. To me my Dr's are one of many resources I use in solving health issues. Far too many people simply do whatever the Dr. says without question. I do ask my Dr. a ton of questions and based on what I find with him as well as other sources I often do request various tests. I treat myself. My Dr. is only a resource to help me to do that. Needless to say, I agree with you. > NorthShoreCEO wrote: > [quoted text clipped - 17 lines] > > Needless to say, I agree with you. Every time I read this, I have to laugh again. You "treat" yourself and your doctor is "only a resource" to help you do that? So you go into your doctors office, tell him your symptoms and what your diagnosis is, tell him what tests you'd like him to write an order for, and off you go. Then, you call your doctor for the results from the lab or pathologist or what have you, and you interpret them and diagnose yourself and then....what? Go get herbs or homeopathic remedies to solve your health issues? Medical newsgroups are great sources of information when people share their experiences, give you the heads up on new medication or treatment they've heard about, or post studies that may pertain to the disease. Yes, sometimes people post results of tests, and people may then say, "You know, that's out of the normal range, you might want to ask your doctor about it". But I always wonder - if people can get online to ask what the test results mean - why the heck didn't they just ask their doctor? Oh don't give me this nonsense that doctors are too busy to go over results. That's their job and it's what they're paid to do. "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2405060758080001@66-52-22-101.lsan.pw-dia.impulse.net... > In article <9XPcg.20291$XV5.13488@fed1read10>, miles > <nope@nopers.com> wrote: [quoted text clipped - 20 lines] > > Needless to say, I agree with you. Every time I read this, I have to laugh again. You "treat" yourself and your doctor is "only a resource" to help you do that? So you go into your doctors office, tell him your symptoms and what your diagnosis is, tell him what tests you'd like him to write an order for, and off you go. Then, you call your doctor for the results from the lab or pathologist or what have you, and you interpret them and diagnose yourself and then....what? Go get herbs or homeopathic remedies to solve your health issues? Medical newsgroups are great sources of information when people share their experiences, give you the heads up on new medication or treatment they've heard about, or post studies that may pertain to the disease. Yes, sometimes people post results of tests, and people may then say, "You know, that's out of the normal range, you might want to ask your doctor about it". But I always wonder - if people can get online to ask what the test results mean - why the heck didn't they just ask their doctor? Oh don't give me this nonsense that doctors are too busy to go over results. That's their job and it's what they're paid to do. Perhaps some doctors have the extra time needed to spend about one hour with each patient. However, most GP doctors only spend about 15 minutes (or less) with most patients answering questions. If patients think of other questions after they have seen their doctors, newsgroups are a resource that can be used to find answers to their questions. Special websites like Medline Plus and webmd.com are also great resources. Do you think that think that a person's doctor is the only resource for finding answers to their questions? I have learned much more about kidney disease from a book that was written by a doctor that is a kidney specialist than I could ever learn from my GP doctor. Jason Do you think that think that a person's doctor is > the only resource for finding answers to their questions? I > have learned [quoted text clipped - 4 lines] > GP doctor. > Jason I think the doctor is usually the best resource with regard to treatment and test results. You can pick up a lot of information on newsgroups, but once people start saying, "post your results and we'll help you", it becomes a dangerous game. There are far too many people online who have their own personal pet theory that they blame every ill on. Like ph levels, for example. "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2405061143020001@66-52-22-37.lsan.pw-dia.impulse.net... Do you think that think that a person's doctor is > the only resource for finding answers to their questions? I > have learned [quoted text clipped - 4 lines] > GP doctor. > Jason I think the doctor is usually the best resource with regard to treatment and test results. You can pick up a lot of information on newsgroups, but once people start saying, "post your results and we'll help you", it becomes a dangerous game. There are far too many people online who have their own personal pet theory that they blame every ill on. Like ph levels, for example. I agree that a person's doctor is the best resource with regard to treatment and test results. However, that does NOT mean there are no other resources. Books, medical websites such as Medline Plus and newsgroups are other resources. Many medical insurance programs don't allow second opinions unless the GP refers the patient. I once had a doctor that refuse to refer me to a specialist. That means that newsgroups are the source for lots of other opinions. That is especially true when real doctors are members of various medical newsgroups. I have read the posts of some of those wonderful doctors and have learned a lot from them. I should note that I first learned about urine pH levels from a doctor (kidney specialist) that wrote a book related to kidney disease. I have NEVER stated that people that do not have health problems should waste their time measuring their urine pH levels. I don't know the reason why several people that have implied or stated that I have done that. However, I do encourage everyone that has acid-base balance problems to read the book that I have mentioned in several posts. Jason > However, I do encourage everyone that has >acid-base balance problems to read the book that I have mentioned >in several posts. Do you have an acid-base problem Jason? If so what is causing the problem? Have you discussed using urine pH with an MD to see if it is useful? RC On Wed, 24 May 2006 13:32:42 -0700, jason@nospam.com (Jason Johnson) wrote: > However, I do encourage everyone that has >acid-base balance problems to read the book that I have mentioned >in several posts. Do you have an acid-base problem Jason? If so what is causing the problem? Have you discussed using urine pH with an MD to see if it is useful? RC RC, I developed some kidney problems as a result of taking statins. However, I have great doctor and have done lots of research such as reading an excellent book entitled, "Coping With Kidney Disease" by Doctor Mackenzie Walser--he's a kidney specialist and a professor at Johns Hopkins University School of Medicine. I do not have kidney disease but know that if I did not eat the proper foods that I would develop kidney disease. I use pH urine test strips and Multistix Reagent Urine Test strips to check 10 other items in relation to urine such as Blood, Protein and Leukocytes. I know that it's possible to control my pH level by eating the proper foods since I do it every week. I recently read an article related to Osteoporosis that was written by a medical doctor. The article states that one of the causes of Osteoporosis is "Prolonged lack of adequate calcium and protein in the diet." It's possible to prevent many diseases by eating a proper diet. That's why I am shocked when I see posts written by people that appear to know lots about medical issues state that it's impossible to control pH by diet. I know they are wrong. Jason > I do not have kidney disease >but know that if I did not eat the proper foods that I would develop >kidney disease. What kind of kidney disease do you think you would get if you did not eat the proper foods? Please be specific about the disease you think you would get and what makes you think that you would get it. If it comforts you to think that eating certain foods will prevent you from getting kidney disease I say more power to you. Unless it is a very bad diet from a nutritional standpoint it is unlikely to harm you so just reducing your anxiety about getting kidney disease might be a good thing. RC On Wed, 24 May 2006 15:29:42 -0700, jason@nospam.com (Jason Johnson) wrote: > I do not have kidney disease >but know that if I did not eat the proper foods that I would develop >kidney disease. What kind of kidney disease do you think you would get if you did not eat the proper foods? Please be specific about the disease you think you would get and what makes you think that you would get it. If it comforts you to think that eating certain foods will prevent you from getting kidney disease I say more power to you. Unless it is a very bad diet from a nutritional standpoint it is unlikely to harm you so just reducing your anxiety about getting kidney disease might be a good thing. RC RC, You would have to read "Coping With Kidney Disease" by Doctor Mackenzie Walser in order to learn the answers to your question. In the book, he explains in detail all of the things on urine tests and various types of blood tests--esp. "hepatic function" and "Renal Panel" that indicate kidney problems. He also explains in detail the symptoms of various kidney deseases. I had many of those symptoms for over a year before my doctor gave my a physical exam and told me that the blood and urine tests indicated that I was having kidney problems. I started conducting research on kidney diseases and learned the treatment program that I should follow to keep from developing ESRD (End Stage Renal Disease). Dr. Walser mentions a special diet plan for kidney patients in his book. He states that kidney patients should not have a high protein diet. Read the book if you don't believe me or conduct research on diet plans for kidney patients. Jason > On Wed, 24 May 2006 15:29:42 -0700, jason@nospam.com (Jason Johnson) > wrote: [quoted text clipped - 19 lines] >You would have to read "Coping With Kidney Disease" by Doctor Mackenzie >Walser in order to learn the answers to your question. How would reading that book answer my question to you of what specific kidney disease do you think you will get if you don't follow the dietary protocol? You say that you don't have kidney disease and yet you think that if you don't follow the protocol for people with kidney disease that you will develop kidney disease? Is that right? If you don't have kidney disease why on earth do you think you would get it if you don't follow the protocol? > I had many of those symptoms for over a year before my doctor >gave my a physical exam and told me that the blood and urine tests >indicated that I was having kidney problems. What specific kidney problem do you have? Did your doctor give you a diagnosis? > I started conducting research >on kidney diseases and learned the treatment program that I should follow >to keep from developing ESRD (End Stage Renal Disease). So you think that you will end up with ESRD if you don't follow the protocol but your doctor does not think that you need a referral to a kidney specialist since your kidney problem is not that serious. Is that right? >Dr. Walser mentions a special diet plan for kidney patients in his book. >He states that kidney patients should not have a high protein diet. That is true. If your kidneys are not performing adequately you should not eat a lot of protein. > Read >the book if you don't believe me or conduct research on diet plans for >kidney patients. Once again I ask you what is your diagnosis with respect to your kidneys. Do you have acute glomerulonephritis, chronic glomerulonephritis, acute renal failure, chronic renal failure, pre-renal failure? What exactly is the nature of your kidney disorder? And don't tell me to read the book since the book does not have the answer to my question unless he wrote the book including you as a case study. RC >Jason On Wed, 24 May 2006 22:02:49 -0700, jason@nospam.com (Jason Johnson) wrote: >In article <vtp97296c7nlboqhdronpam1e0mqb3p5t1@4ax.com>, >rchrdcarlisle@NOTyahoo.com wrote: [quoted text clipped - 19 lines] >You would have to read "Coping With Kidney Disease" by Doctor Mackenzie >Walser in order to learn the answers to your question. How would reading that book answer my question to you of what specific kidney disease do you think you will get if you don't follow the dietary protocol? You say that you don't have kidney disease and yet you think that if you don't follow the protocol for people with kidney disease that you will develop kidney disease? Is that right? If you don't have kidney disease why on earth do you think you would get it if you don't follow the protocol? > I had many of those symptoms for over a year before my doctor >gave my a physical exam and told me that the blood and urine tests >indicated that I was having kidney problems. What specific kidney problem do you have? Did your doctor give you a diagnosis? > I started conducting research >on kidney diseases and learned the treatment program that I should follow >to keep from developing ESRD (End Stage Renal Disease). So you think that you will end up with ESRD if you don't follow the protocol but your doctor does not think that you need a referral to a kidney specialist since your kidney problem is not that serious. Is that right? >Dr. Walser mentions a special diet plan for kidney patients in his book. >He states that kidney patients should not have a high protein diet. That is true. If your kidneys are not performing adequately you should not eat a lot of protein. > Read >the book if you don't believe me or conduct research on diet plans for >kidney patients. Once again I ask you what is your diagnosis with respect to your kidneys. Do you have acute glomerulonephritis, chronic glomerulonephritis, acute renal failure, chronic renal failure, pre-renal failure? What exactly is the nature of your kidney disorder? And don't tell me to read the book since the book does not have the answer to my question unless he wrote the book including you as a case study. RC As a result of a routine yearly physical exam, my doctor told me that my creatinine level was above normal. More detailed blood and urine tests were done and the doctors determined that I had "Metabolic Acidosis". Since I had kidney disease when I was an infant, the doctor concluded that I had to make some major changes in my diet to reduce the high acid levels. That's when I conducted research on Metabolic Acidosis which lead to even more research related to kidney disease. When I read Dr. Walser's kidney book, it became obvious that I had (and still have) many of the top ten symptoms of kidney disease. See these sites: http://www.mydna.com/health/kidney/topten/topkidsymp.html http://www.nlm.nih.gov/medlineplus/ency/article/002442.htm It sounds like he has some kind of renal tubular acidosis. Depending on his bicarb it might be reasonable for him to watch his urine pH and serum bicarb and keep them normal with diet or supplements. That doesn't mean that he will go into ESRD if he doesn't follow the diet (it is hard to say for sure but probably not the case) or that any of this has anything to do with anything other than a person with certain forms of RTA. Signature00doc It sounds like he has some kind of renal tubular acidosis. Depending on his bicarb it might be reasonable for him to watch his urine pH and serum bicarb and keep them normal with diet or supplements. That doesn't mean that he will go into ESRD if he doesn't follow the diet (it is hard to say for sure but probably not the case) or that any of this has anything to do with anything other than a person with certain forms of RTA. That's probably true--however, I don't know for sure--since my doctor has to follow the rules of my insurance company. He can NOT refer me to a kidney specialist to get a biophy (on my kidneys) unless he has test results to justify his decision. He did recently refer me to a urologist since a recent urine test ("urinalysis W/MICRO") indicated that I had "Urine RBC's RARE A" which the doctor told me that it meant that I had blood in my urine. He referred me to a urologist. I wish that he had referred me to a kidney specialist but as you know--I can't tell him what to do. I realize that he has to follow the rules of the insurance company. Can a urologist do a kidney biopsy? I should note that my creatinine level is now 1.1--mainly because I no longer eat meat. If the creatinine level has been above normal--he probably would have referred me to a kidney specialist instead of a urologist. Jason Urologists generally deal with the ureters (tubes that go from the kidney to the bladder, bladder, and prostate. They stop at the kidney so it woul dbe unusual for one to do kidney biopsies. Blood can come from anywhere along there so it is worth it for him to take a look. of course, it could be comming from your kidneys as well. I obviously don't know the "ins and outs" of your insurance but it would be unusual for him not to be able to refer you if there are signs of renal disease (metabolic acidosis would be one - blood in the urine is another). Kidney biopsies are not done much in the US but there are other things that a nephrologist could do like accurately diagnose the type of acidosis. Signature00doc Urologists generally deal with the ureters (tubes that go from the kidney to the bladder, bladder, and prostate. They stop at the kidney so it woul dbe unusual for one to do kidney biopsies. Blood can come from anywhere along there so it is worth it for him to take a look. of course, it could be comming from your kidneys as well. I obviously don't know the "ins and outs" of your insurance but it would be unusual for him not to be able to refer you if there are signs of renal disease (metabolic acidosis would be one - blood in the urine is another). Kidney biopsies are not done much in the US but there are other things that a nephrologist could do like accurately diagnose the type of acidosis. Based upon what I read in the book that was written by a nephrologist, you are 100% correct related to the other things that a nephrologist could do to diagnose the type of acidosis or kidney disease. For example, the nephrologist are experts in determining the Glomerular Filtration Rate (GFR). They also have special urine tests for potassium and calcium. I just hope that urologist can determine the source of the blood in the urine. It's only a trace amount of blood and there was no protein found in the urine which was great news. Jason > They also have special urine tests for potassium and calcium. I >just hope that urologist can determine the source of the blood in the >urine. Did you have blood in your urine on repeated urinalyses or just a single one. If a single on then it should be repeated. Are you very physically active such as running, bicycling, etc? You can get rare blood in your urine from trauma secondary to excessive physical activity. > It's only a trace amount of blood and there was no protein found in >the urine which was great news. A urologist can do a cystoscopy where he look up your urethra to see if there is a visible source for the blood in your urine. RC On Thu, 25 May 2006 15:41:01 -0700, jason@nospam.com (Jason Johnson) wrote: > They also have special urine tests for potassium and calcium. I >just hope that urologist can determine the source of the blood in the >urine. Did you have blood in your urine on repeated urinalyses or just a single one. If a single on then it should be repeated. Are you very physically active such as running, bicycling, etc? You can get rare blood in your urine from trauma secondary to excessive physical activity. > It's only a trace amount of blood and there was no protein found in >the urine which was great news. A urologist can do a cystoscopy where he look up your urethra to see if there is a visible source for the blood in your urine. RC RC, Thanks for your post. I was not aware that a urologist could do that sort of thing--that is really good news. Yes--I ride an exercise bike 4 miles per day--6 days per week--at the local health fitness center. Results of two separate urine tests in two different labs: 10/3/05 Red Blood Cells (/HPF) 2 reference range 0 to 4 5/11/05 Urine RBC's (W/MICRO) RARE A reference range NONE My doctor told me that there should be NO red blood cells in the urine which is the reason he referred me to a urologist. It's my guess that he would have referred me to a kidney specialist if the blood creatinine level (and other items on the Renal Panel) were outside of the expected range. My creatinine level was 1.1--probably due to the fact that I no longer eat meat. My doctor needs a medical reason to refer me to a kidney specialist. Jason >RC, >Thanks for your post. I was not aware that a urologist could do that sort >of thing--that is really good news. If you think cystoscopy is good news you are one optimistic guy:-) >Yes--I ride an exercise bike 4 miles per day--6 days per week--at the >local health fitness center. I would stop all exercise for a week and then repeat the urinalysis. It might come up clean and further tests unnecessary. Within a week all blood secondary to exercise should have cleared out completely. >Results of two separate urine tests in two different labs: >10/3/05 Red Blood Cells (/HPF) 2 reference range 0 to 4 >5/11/05 Urine RBC's (W/MICRO) RARE A reference range NONE >My doctor told me that there should be NO red blood cells in the urine >which is the reason he referred me to a urologist. It is true that any red blood cells in urine for a man can be significant although rare blood cells may not be cause for concern. Best to err on the side of caution and get it checked out. It is funny that you had two tests with two different reference ranges. Did you use a different lab for the two tests? Good luck. RC On Thu, 25 May 2006 19:18:41 -0700, jason@nospam.com (Jason Johnson) wrote: >RC, >Thanks for your post. I was not aware that a urologist could do that sort >of thing--that is really good news. If you think cystoscopy is good news you are one optimistic guy:-) >Yes--I ride an exercise bike 4 miles per day--6 days per week--at the >local health fitness center. I would stop all exercise for a week and then repeat the urinalysis. It might come up clean and further tests unnecessary. Within a week all blood secondary to exercise should have cleared out completely. >Results of two separate urine tests in two different labs: >10/3/05 Red Blood Cells (/HPF) 2 reference range 0 to 4 >5/11/05 Urine RBC's (W/MICRO) RARE A reference range NONE >My doctor told me that there should be NO red blood cells in the urine >which is the reason he referred me to a urologist. It is true that any red blood cells in urine for a man can be significant although rare blood cells may not be cause for concern. Best to err on the side of caution and get it checked out. It is funny that you had two tests with two different reference ranges. Did you use a different lab for the two tests? Good luck. RC RC, No, I had a insurance related mini-physical exam (blood pressure test, blood test and urine test). The nurse sent the blood and urine to a different lab than the local hospital lab. My doctor sends me to the local hospital lab to get my blood and urine tests. That's the reason two different labs were mentioned in my post. I gave my doctor a copy of the blood and urine tests from the other lab. That's why he had similar tests done at the local hospital lab. You made this statement in your post: >>If you think cystoscopy is good news you are one optimistic guy:-) I am not looking forward to having the procedure done but do believe it's good news that the procedure may determine the reason that I have blood in my urine. For the past year, I have been wondering and guessing as to the exact reason for my symptoms. If I was rich, I would use my own money to pay for a kidney biopsy to rule in or out kidney disease. If I do have kidney disease, I would like to know which one that I have. I don't blame my doctor--instead I blame the medical insurance company for having rules that prohibit doctors from sending people like me for a biopsy even if they are not 100% sure that I have kidney disease. Jason >If I was rich, I would use my own money to pay for >a kidney biopsy to rule in or out kidney disease. Good thing that you are not rich. Kidney biopsies are not completely benign procedures. They should only be done if there is a reasonable suspicion of kidney disease. It sounds like only you think that kidney disease is a likely possibility. Your own doctor does not even think it warranted to send you to a kidney specialist. RC On Fri, 26 May 2006 07:57:22 -0700, jason@nospam.com (Jason Johnson) wrote: >If I was rich, I would use my own money to pay for >a kidney biopsy to rule in or out kidney disease. Good thing that you are not rich. Kidney biopsies are not completely benign procedures. They should only be done if there is a reasonable suspicion of kidney disease. It sounds like only you think that kidney disease is a likely possibility. Your own doctor does not even think it warranted to send you to a kidney specialist. RC RC, However, he did refer me to a urologist. Jason > On Fri, 26 May 2006 07:57:22 -0700, jason@nospam.com (Jason Johnson) > wrote: [quoted text clipped - 12 lines] >RC, >However, he did refer me to a urologist. Which is perfectly reasonable considering that you had RBC's in your urine. However I would have suggested your repeating the urinalysis after a week of being sedentary (not exercising). RC >Jason On Fri, 26 May 2006 16:16:35 -0700, jason@nospam.com (Jason Johnson) wrote: >In article <7m8e72hgh6mh9n9250kpvaui0rl679uv12@4ax.com>, >rchrdcarlisle@NOTyahoo.com wrote: [quoted text clipped - 12 lines] >RC, >However, he did refer me to a urologist. Which is perfectly reasonable considering that you had RBC's in your urine. However I would have suggested your repeating the urinalysis after a week of being sedentary (not exercising). RC RC, That is excellent advice that I will take. The next time I have to take a urine test, I will not exercise one week prior to the test. I know that kidney specialists do GFR tests--do you know whether or not urologists do GFR tests on patients that have edema? jason >RC, >That is excellent advice that I will take. The next time I have to take a >urine test, I will not exercise one week prior to the test. I know that >kidney specialists do GFR tests--do you know whether or not urologists do >GFR tests on patients that have edema? A nephrologist would not do a GFR test if you have edema if your creatinine is normal. Are you aware that there are many causes for edema and that kidney disease is pretty low down on the list especially if your creatinine is normal? Did you ask your primary care doctor about the edema and what was causing it? I hope you told him about the edema. Edema secondary to kidney disease is a result of protein being lost in the urine and the lack of osmotic pressure to hold fluid in the vascular system. Did you not say that there was no protein in your urine? I would suggest that you stop worrying about the possibility that you have kidney disease. Did you not tell OOdoc that you would take his advice since he did not think you had kidney disease. I guess it is hard to take that advice when you cannot stop thinking about that possibility. You might want to consider psychiatric help if your obsessive thinking about having some disease continues unabated. RC On Fri, 26 May 2006 17:44:08 -0700, jason@nospam.com (Jason Johnson) wrote: >RC, >That is excellent advice that I will take. The next time I have to take a >urine test, I will not exercise one week prior to the test. I know that >kidney specialists do GFR tests--do you know whether or not urologists do >GFR tests on patients that have edema? A nephrologist would not do a GFR test if you have edema if your creatinine is normal. Are you aware that there are many causes for edema and that kidney disease is pretty low down on the list especially if your creatinine is normal? Did you ask your primary care doctor about the edema and what was causing it? I hope you told him about the edema. Edema secondary to kidney disease is a result of protein being lost in the urine and the lack of osmotic pressure to hold fluid in the vascular system. Did you not say that there was no protein in your urine? I would suggest that you stop worrying about the possibility that you have kidney disease. Did you not tell OOdoc that you would take his advice since he did not think you had kidney disease. I guess it is hard to take that advice when you cannot stop thinking about that possibility. You might want to consider psychiatric help if your obsessive thinking about having some disease continues unabated. RC RC, I don't plan to discuss a biopy with my doctor in the near future. However, I am going to request copies of all future blood and urine tests and will request a referral to a nephrologist if I see numbers (eg high creatinine levels) indicating that I have serious kidney problems. I did discuss the edema problem with my doctor. He tested my blood pressure while I was setting down and again when I stood up. He stated that I did have edema but that it was not a serious case of edema but was something to "keep an eye on". I know that there are several causes of edema. I just checked my 2005 and 2005 blood tests and urine tests and only saw Protein listed on one of the urine tests. It indicated that I had 1 MG% of protein in my urine. My doctor said that it was nothing to be concerned about. I found it surprising that PROTEIN was not even tested on my most recent kidney function urine test. I will ask my doctor to test Protein on my next urine test--thanks for the advice. I don't think that people that are concerned about various symptoms they have never had before need psychiatric help. Believe it or not, lots of people visit their doctors about once a month. I visit my doctor once every three months. jason >RC, >I don't plan to discuss a biopy with my doctor in the near future. Hopefully not in the distant future either. >However, I am going to request copies of all future blood and urine tests >and will request a referral to a nephrologist if I see numbers (eg high >creatinine levels) indicating that I have serious kidney problems. You keep obsessing about the possibility that you are going to get a serious kidney problem. This is not healthy for you to do. Your kidneys are probably fine and will probably be fine for the rest of your life. Nothing in your history suggests that you have any kidney disease. > I did >discuss the edema problem with my doctor. He tested my blood pressure >while I was setting down and again when I stood up. He stated that I did >have edema but that it was not a serious case of edema but was something >to "keep an eye on". Did he tell you what is causing the edema? Where is the edema? > I know that there are several causes of edema. I just >checked my 2005 and 2005 blood tests and urine tests and only saw Protein [quoted text clipped - 3 lines] >kidney function urine test. I will ask my doctor to test Protein on my >next urine test--thanks for the advice. Protein should be tested with all routine urinalysis. Are you sure it was not tested and came up with zero? > I don't think that people that are >concerned about various symptoms they have never had before need >psychiatric help. You are quite correct. However someone who keeps obsessing about his symptoms and blood/urine tests convinced that he has or will get kidney disease is pathologic. Your doctor has reassured you. I have reassured you. OOdoc has reassured you and yet you are still obsessing about having kidney disease or getting it some time in the future. You also mentioned the possibility of rhabdo causing acute tubular necrosis or ARF and you had none of those things so why on earth you even brought them up is beyond me. Obviously you think that you might have any or all of them but there is absolutely no basis for you to think that. That is why I am entertaining the possibility that your primary problem is psychiatric. > Believe it or not, lots of people visit their doctors >about once a month. So what? Some people see their doctors every day especially when hospitalized. And sometimes people see doctors twice a week as outpatients. Frequency of visits is determined by the nature of the problem. > I visit my doctor once every three months. That means nothing. You might be seeing your doctor too often or not often enough depending on your problem. My hunch is that it is more likely you are seeing your doctor more than you need due to your excessive worrying that something is seriously wrong with you. I bet your primary doctor spends a lot of time trying to reassure you that you don't have a serious problem. RC >jason On Fri, 26 May 2006 19:11:03 -0700, jason@nospam.com (Jason Johnson) wrote: >RC, >I don't plan to discuss a biopy with my doctor in the near future. Hopefully not in the distant future either. >However, I am going to request copies of all future blood and urine tests >and will request a referral to a nephrologist if I see numbers (eg high >creatinine levels) indicating that I have serious kidney problems. You keep obsessing about the possibility that you are going to get a serious kidney problem. This is not healthy for you to do. Your kidneys are probably fine and will probably be fine for the rest of your life. Nothing in your history suggests that you have any kidney disease. > I did >discuss the edema problem with my doctor. He tested my blood pressure >while I was setting down and again when I stood up. He stated that I did >have edema but that it was not a serious case of edema but was something >to "keep an eye on". Did he tell you what is causing the edema? Where is the edema? No, he knew about the serious side effects that I had in relation to taking statins. He "suspected" that my organs were still in the process of recovering from those side effects and that was the source of the edema. He believes that my edema will not be a problem before this same time next year. He did not do any tests to determine the exact cause of the edema. As I have stated in other posts, it's my guess that the edema is related to Renal Tubular Necrosis but it's only a guess since a biopsy had never been done. My doctor will probably do more tests related to the source of the edema if it's still a problem this same time next year. The edema was one of the reasons that I wanted to be referred to a kidney specialist to rule in or out kidney disease as the cause of the edema. I should note that "generalized swelling and fluid retention" are one of the symptoms of renal tubular necrois. Visit this site for proof: http://www.nlm.nih.gov/medlineplus/ency/article/000512.htm > I know that there are several causes of edema. I just >checked my 2005 and 2005 blood tests and urine tests and only saw Protein [quoted text clipped - 3 lines] >kidney function urine test. I will ask my doctor to test Protein on my >next urine test--thanks for the advice. Protein should be tested with all routine urinalysis. Are you sure it was not tested and came up with zero? Unless there is another term for protein, it is NOT listed. I did note that it was "micro" urine test instead of a regular urine test. That may be the reason protein was not tested. > I don't think that people that are >concerned about various symptoms they have never had before need >psychiatric help. You are quite correct. However someone who keeps obsessing about his symptoms and blood/urine tests convinced that he has or will get kidney disease is pathologic. Your doctor has reassured you. I have reassured you. OOdoc has reassured you and yet you are still obsessing about having kidney disease or getting it some time in the future. You also mentioned the possibility of rhabdo causing acute tubular necrosis or ARF and you had none of those things so why on earth you even brought them up is beyond me. Obviously you think that you might have any or all of them but there is absolutely no basis for you to think that. That is why I am entertaining the possibility that your primary problem is psychiatric. The only evidence that I developed Rhab. as a result of taking statins is a blood test that showed that my blood creatinine rose from 1.1 to 1.7 while I was still taking statins. My muscles also hurt during that period of time. My doctor prescribed a different statin that had a low dose and the problem continued. She told me that I should stop taking statins. In reviewing the blood tests and urine tests from that period of time, there were NO urine tests done while I was taking statins. Therefore, it's only a guess (re: Rhab) since the the proper tests were not done. I now have a new doctor. My former doctor should have done special blood and urine tests when I developed muscle problems and creatinine problems as a direct result of taking statins. Those tests would have revealed whether or not I developed rhab. as a result of taking statins. > Believe it or not, lots of people visit their doctors >about once a month. So what? Some people see their doctors every day especially when hospitalized. And sometimes people see doctors twice a week as outpatients. Frequency of visits is determined by the nature of the problem. > I visit my doctor once every three months. That means nothing. You might be seeing your doctor too often or not often enough depending on your problem. My hunch is that it is more likely you are seeing your doctor more than you need due to your excessive worrying that something is seriously wrong with you. I bet your primary doctor spends a lot of time trying to reassure you that you don't have a serious problem. That's true. But he also does blood tests and urine tests every three months to "keep an eye" on kidney and liver function. He believes that I have what he calls "weak kidneys" but that I do not have a kidney disease. He believes the weak kidneys were probably caused by the statin related side effects and that they will recover over time. That's the reason he believes that I have edema which is the reason he has not done tests. RC >I should note that "generalized swelling and fluid retention" are one of >the symptoms of renal tubular necrois. Visit this site for proof: >http://www.nlm.nih.gov/medlineplus/ency/article/000512.htm Jason reminds me of the Billy Crystal character in City Slickers. His wife said that when he was asked what he wanted for his birthday he said a CAT scan because he thought he might have a brain tumor and he replied "I had a headache". Look it up. Headache is a symptom of a brain tumor. Could you imagine if everyone who had a headache got a CAT scan to rule out brain tumor? He also reminds me of a Woody Allen character. Woody's friend: You thought you had melanoma Woody: I had a spot on my back Woody's friend: The spot was on your sweater. RC > On Sat, 27 May 2006 11:56:12 -0700, jason@nospam.com (Jason > Johnson) [quoted text clipped - 26 lines] > > RC Jason, this is another reason you should be careful of what information you entrust people with on the internet. This poster accuses you of needing psychiatric help, yet he goes on to mock and deride you. Any person who believes an individual needs help, and then goes on to mock that person, has issues of his own he should be dealing with. <rchrdcarlisle@NOTyahoo.com> wrote in message news:vc9h721b9gmtd2fms23020un80klbpp8tt@4ax.com... > On Sat, 27 May 2006 11:56:12 -0700, jason@nospam.com (Jason > Johnson) [quoted text clipped - 26 lines] > > RC Jason, this is another reason you should be careful of what information you entrust people with on the internet. This poster accuses you of needing psychiatric help, yet he goes on to mock and deride you. Any person who believes an individual needs help, and then goes on to mock that person, has issues of his own he should be dealing with. Yes, I knew that. I see such those kinds of posts in newsgroups and quickly move to the next post. It's easy for me to determine which posts to respond to--if you have noticed--I don't respond to those sorts of posts. > In article <ILqdneWgLa0XLeXZnZ2dnUVZ_uqdnZ2d@comcast.com>, > "NorthShoreCEO" [quoted text clipped - 6 lines] > own > he should be dealing with. > Yes, I knew that. I see such those kinds of posts in newsgroups > and > quickly move to the next post. It's easy for me to determine > which posts to respond to--if you have noticed--I don't respond > to > those sorts of posts. I noticed, and the best response is no response. I think many of us have learned to ignore certain posts. And posters. "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2705061413440001@66-52-22-6.lsan.pw-dia.impulse.net... > In article <ILqdneWgLa0XLeXZnZ2dnUVZ_uqdnZ2d@comcast.com>, > "NorthShoreCEO" [quoted text clipped - 6 lines] > own > he should be dealing with. > Yes, I knew that. I see such those kinds of posts in newsgroups > and > quickly move to the next post. It's easy for me to determine > which posts to respond to--if you have noticed--I don't respond > to > those sorts of posts. I noticed, and the best response is no response. I think many of us have learned to ignore certain posts. And posters. I agree. One of the medical newsgroup (sci.med.cardiology) was one of the newsgroups that I once enjoyed since I learned so much about medications for treating blood pressure problems and heart problems. Most of the posts are now unrelated to medical information--instead most of the posts are related to religion. That's really sad since so many people have blood pressure problems and heart problems. They have probably lost most of the regular members of that newsgroup. Jason > I just > checked my 2005 and 2005 blood tests and urine tests and only saw Protein > listed on one of the urine tests. It indicated that I had 1 MG% of protein > in my urine. That is a small amount. If you really want it quantised they could to a "spot" creatinine/albumin ratio on one urine sample or a 24 hour urine collection. > My doctor said that it was nothing to be concerned about. I > found it surprising that PROTEIN was not even tested on my most recent > kidney function urine test. It may be listed as albumin. Signature00doc "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2605061911040001@66-52-22-20.lsan.pw-dia.impulse.net... > I just > checked my 2005 and 2005 blood tests and urine tests and only saw Protein > listed on one of the urine tests. It indicated that I had 1 MG% of protein > in my urine. That is a small amount. If you really want it quantised they could to a "spot" creatinine/albumin ratio on one urine sample or a 24 hour urine collection. > My doctor said that it was nothing to be concerned about. I > found it surprising that PROTEIN was not even tested on my most recent > kidney function urine test. It may be listed as albumin. Albumin was listed on the 5/11/06 urine test. It states "negative" which is good news. > RC, > That is excellent advice that I will take. The next time I have to take a > urine test, I will not exercise one week prior to the test. I know that > kidney specialists do GFR tests--do you know whether or not urologists do > GFR tests on patients that have edema? > jason You have had a "GFR" test. Your creatinine is 1.1 and the GFR can be calculated from that. There are several methods and it is not hard to find the formulas or calculators to figure it out for you on any search engine. If you try and have trouble let me know. Directly measuring GFR is sufficiently hard to do (usually involves infusions of a chemical called inulin) that it is virtually never done. There is active research on better ways to estimate kidney function (someone suggested one recently but I forget the details) but none have become commonly accepted. Signature00doc "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2605061744090001@66-52-22-20.lsan.pw-dia.impulse.net... > RC, > That is excellent advice that I will take. The next time I have to take a > urine test, I will not exercise one week prior to the test. I know that > kidney specialists do GFR tests--do you know whether or not urologists do > GFR tests on patients that have edema? > jason You have had a "GFR" test. Your creatinine is 1.1 and the GFR can be calculated from that. There are several methods and it is not hard to find the formulas or calculators to figure it out for you on any search engine. If you try and have trouble let me know. Directly measuring GFR is sufficiently hard to do (usually involves infusions of a chemical called inulin) that it is virtually never done. There is active research on better ways to estimate kidney function (someone suggested one recently but I forget the details) but none have become commonly accepted. Yes, you are correct. Dr. Walser (kidney specialist and professor) discusses GFR in his book. Kidney specialists measure it in various ways. Dr. Walser (he works at Johns Hopkins) has a detailed method such as collecting three timed urine samples while a marker is infused intravenously at a constant rate. He also mentions a method that involves injecting a GFR substance and taking blood samples during the ensuing hours to determine the rate that it disapears from the body. I believe that the method that you mentioned is less precise than the method that Dr. Walser makes use of. Jason > > RC, > > That is excellent advice that I will take. The next time I have to take [quoted text clipped - 20 lines] > discusses GFR in his book. Kidney specialists measure it in various ways. > Dr. Walser (he works at Johns Hopkins) Great institution. It is consitently named by US News and World Report (something like 15 years in a row) as the best hospital in the country. He must be truly impressive. :-) [Sorry, I couldn't resist] > has a detailed method such as > collecting three timed urine samples while a marker is infused [quoted text clipped - 3 lines] > that the method that you mentioned is less precise than the method that > Dr. Walser makes use of. To really measure it you need to infuse a compound that is only secreted from the body by glomerular filtration - not by the liver or any other organ or metabolised (like most things) not by the renal tubules (like creatinine) and not resorbed by the renal tubules (like urea). You then measure the serum concentration when it is in a steady state and the urine concentration and volume (which gives the total excreted over a unit of time). From this you can calculate a direct GFR. Usually the substance used is inulin (not to be confused with insulin) but there are a few others. This test is almost never done. I've never heard of it being done in clinical practice but I threw in "almost" to be nice. You have a better chance of being hit by lightning on the day you win the lottery than you have of getting this test done. What is done is that the creatinine is measured and any one of several formulas are used to calculate an estimated GFR. This is not perfect but it is good enough for nearly all applications. As I mentioned before several people are working on more accurate ways to make quick estimations but no one is talking about directly measuring it. Signature00doc "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2705061216120001@66-52-22-6.lsan.pw-dia.impulse.net... > In article <hLGdnQ-SuLDp8-XZnZ2dnUVZ_v2dnZ2d@comcast.com>, "00doc" > <00doc@comcast.net> wrote: [quoted text clipped - 25 lines] > discusses GFR in his book. Kidney specialists measure it in various ways. > Dr. Walser (he works at Johns Hopkins) Great institution. It is consitently named by US News and World Report (something like 15 years in a row) as the best hospital in the country. He must be truly impressive. :-) [Sorry, I couldn't resist] > has a detailed method such as > collecting three timed urine samples while a marker is infused [quoted text clipped - 3 lines] > that the method that you mentioned is less precise than the method that > Dr. Walser makes use of. To really measure it you need to infuse a compound that is only secreted from the body by glomerular filtration - not by the liver or any other organ or metabolised (like most things) not by the renal tubules (like creatinine) and not resorbed by the renal tubules (like urea). You then measure the serum concentration when it is in a steady state and the urine concentration and volume (which gives the total excreted over a unit of time). From this you can calculate a direct GFR. Usually the substance used is inulin (not to be confused with insulin) but there are a few others. This test is almost never done. I've never heard of it being done in clinical practice but I threw in "almost" to be nice. You have a better chance of being hit by lightning on the day you win the lottery than you have of getting this test done. What is done is that the creatinine is measured and any one of several formulas are used to calculate an estimated GFR. This is not perfect but it is good enough for nearly all applications. As I mentioned before several people are working on more accurate ways to make quick estimations but no one is talking about directly measuring it. Should I ask the urol. to calculate my GFR and tell me the meaning of those results or should I ask my regular doctor (internist) to calculate the GFR? Jason > Should I ask the urol. to calculate my GFR and tell me the meaning of > those results or should I ask my regular doctor (internist) to calculate > the GFR? http://www.nephron.com/cgi-bin/MDRD_GFR.cgi This site has several different calculators. Click on the links below the one that dosplays at the top to do it several different ways. By inputting that you are a 55 you whilte male with a creatnine of 1.1 the GFR comes out to 74 ml/min/1.73 m2 Some of the other ones ask for other info such as weight and albumin. Signature00doc "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2705061422380001@66-52-22-6.lsan.pw-dia.impulse.net... > Should I ask the urol. to calculate my GFR and tell me the meaning of > those results or should I ask my regular doctor (internist) to calculate > the GFR? http://www.nephron.com/cgi-bin/MDRD_GFR.cgi This site has several different calculators. Click on the links below the one that dosplays at the top to do it several different ways. By inputting that you are a 55 you whilte male with a creatnine of 1.1 the GFR comes out to 74 ml/min/1.73 m2 Some of the other ones ask for other info such as weight and albumin. doc, Thanks for your post. I'll make a hard copy of your post and visit the site later today. I believe that there is a chapter in Doctor Walser's kidney book that explains the meaning of the results. You are a great doctor. I have noticed that you have provided some really great advice to people that have even more serious problems than I have--that's great. Keep up the great work. Jason > On Fri, 26 May 2006 07:57:22 -0700, jason@nospam.com (Jason Johnson) > wrote: [quoted text clipped - 13 lines] > However, he did refer me to a urologist. > Jason Right, he did. I think that he showed a very low threshold for sending you. I suspect that this might pertain to you specifically and not his general tendancy. Probably (and I am completely making wild guesses here), he would rather have repeated it and reassured you that nothing was wrong (as most docs would ahve done) but he knew from past experience what the result of that would have been so he "punted" and sent you to a specialist. Did he order an ultrasound or spiral CT of the abdomen and pelvis (as he would have done if he was really worried about the blood)? If not, don't worry, I'm sure the urologist will. But anyway, one has to ask - If he was so quick to send you to a urologist why is he so slow to send you to a nephrologist? Most likely the answer is that he cannot think of even a minor reason to do so. He is willing to be very cautious but not more than that. Signature00doc "Jason Johnson" <jason@nospam.com> wrote in message news:jason-2605061616350001@66-52-22-34.lsan.pw-dia.impulse.net... > In article <7m8e72hgh6mh9n9250kpvaui0rl679uv12@4ax.com>, > rchrdcarlisle@NOTyahoo.com wrote: [quoted text clipped - 13 lines] > However, he did refer me to a urologist. > Jason Right, he did. I think that he showed a very low threshold for sending you. I suspect that this might pertain to you specifically and not his general tendancy. Probably (and I am completely making wild guesses here), he would rather have repeated it and reassured you that nothing was wrong (as most docs would ahve done) but he knew from past experience what the result of that would have been so he "punted" and sent you to a specialist. Did he order an ultrasound or spiral CT of the abdomen and pelvis (as he would have done if he was really worried about the blood)? If not, don't worry, I'm sure the urologist will. But anyway, one has to ask - If he was so quick to send you to a urologist why is he so slow to send you to a nephrologist? Most likely the answer is that he cannot think of even a minor reason to do so. He is willing to be very cautious but not more than that. Doc, I can only guess. He has to have a "medical reason" to refer me to a specialist. In the case of the "red blood cells in the urine", he probably referred me to a urologist since he felt it was unrelated to kidney problems. As you have stated in your posts, there are no blood tests or urine tests that indicate that I have kidney disease. It may be his "guess" that a trace of blood in the urine is nothing to be concerned about but he knows that it might be an indication of a more serious problem. All doctors (as you know) have to worry about lawsuits so they send people like me to specialists to protect themselves from future lawsuits. I once read an article that indicated that the majority of special tests and referrals were done to protect doctors from lawsuits. Do you agree or disagree with me? For these same reasons, I am surprised that he is ignoring the edema problem that I am having. He suspects the edema problem will clear up as my organs recover from the side effects (eg 1.7 MG.DL creatinine levels) of statins. I no longer take statins. Jason > For the past year, I have been wondering and guessing as to the exact > reason for my symptoms. If I was rich, I would use my own money to pay for [quoted text clipped - 3 lines] > that prohibit doctors from sending people like me for a biopsy even if > they are not 100% sure that I have kidney disease. To be honest, and I could be missing something here (the vagaries of Usenet), but from everything I have read it sounds like you don't have kidney disease and that a biopsy is not warranted and should not be done no matter how much money or what insurance you had. I suspect that your doc does not think you need a referral (or biopsy) and is using the insurance issue as a polite excuse. Maybe you should explore why you are so fixated on having a biopsy? Signature00doc >> For the past year, I have been wondering and guessing as to the exact >> reason for my symptoms. If I was rich, I would use my own money to pay for [quoted text clipped - 10 lines] >does not think you need a referral (or biopsy) and is using the insurance >issue as a polite excuse. You might be correct about the doctor using the insurance as an excuse. I think this is a mistake. He needs to be straight with his patients and explain clearly why he does not think that further tests or a referral is indicated. He is just shifting the blame to the insurance company and for all you know Jason will start sending nasty letters to them saying that if it was not for them that he would get the necessary tests. >Maybe you should explore why you are so fixated on having a biopsy? It is clear why he is fixated on having a biopsy or at least seeing a nephrologist. He is completely convinced (delusional?) that he has the early stages of some kidney disease. He clearly said that if he ate enough protein in his diet that in 3 years he would have end stage renal disease. I wonder if he told his doctor that he believes this. Based on his responses here, I think he is delusional and nothing will convince him otherwise. Another possibility is that he has factitious disorder and is deriving some secondary gain by being a patient with an illness. My sense is that he does not think that his doctor is taking his concerns seriously and is not giving enough of his time. Usenet is a poor substitute for a real doctor. |
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